Welcome to Open Enrollment 2024!
Benefits Overview
Medical Insurance provided through Cigna
HSA 5000 Plan - Single Deductible - $5,000 / Family Deductible - $10,000 (In-Network)
Dental Insurance provided though Guardian
Dental Plan - Single Deductible - $50 / Family Deductible - $150 (In-Network)
Vision Insurance provided though VSP
Vision Plan - Exam Copay - $10
Disability Insurance provided though MetLife
Short Term Disability and Long Term Disability
Basic Life and AD&D Insurance provided though MetLife
Company paid Basic Life and AD&D Insurance
Eligibility & Qualifying Events
The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire year.
EMPLOYEE ELIGIBILITY
- You are eligible to participate if you are full-time and work a minimum of 30 hours per week.
- New hires are eligible for coverage on the first day of the month following 30 days of employment.
- Eligible employees may make their benefit elections during the annual Open Enrollment for a May 1, 2024 effective date. If you do not enroll during this Open Enrollment period, you must wait until the next Open Enrollment period unless you experience a Qualifying Life Event.
DEPENDENT ELIGIBILITY
You may also enroll eligible dependents for benefits coverage. A ‘dependent’ is defined as the legal spouse and/or ‘dependent child(ren)’ of the plan participant or the spouse.
What is a Qualifying Life Event (QLE)?
- Marriage
- Divorce
- Birth/Adoption of a child
- Death of a spouse or other enrolled dependent
- Change in spouse’s benefits or employment status
- A dependent becomes eligible for Medicare or Medicaid
The term ‘child’ refers to any of the following:
- A natural (biological) child
- A stepchild
- A legally adopted child
- A foster child
- A child for whom legal guardianship has been awarded to the participant or the participant’s spouse
- Disabled dependents may be eligible if requirements set by the plan are met.
IMPORTANT
You cannot make changes to these elections during the year unless you experience a qualified family status change, which must be reported to Human Resources within 30 days of the event. You can, however, modify your elections under certain circumstances, called "Qualifying Events" These are events such as marriage, divorce, birth or adoption of a child, loss of eligibility under another plan. If you experience a qualifying event, you may make changes to your benefits within 30 days of the event or 60 days if the event is due to birth or adoption of a child.
If you separate from employment, COBRA continuation of coverage may be available as applicable by law. COBRA Continuation details can be found in the notices section of this employee benefit guide.
Video Preview
Medical - Cigna
HSA 5000 Plan Details
IN NETWORK
DEDUCTIBLE:
- Single Deductible - $5,000
- Family Deductible - $10,000
COINSURANCE (applies after deductible is met): 100%
COINSURANCE MAX SINGLE: $0
COINSURANCE MAX FAMILY: $0
OUT-OF-POCKET (OOP) MAXIMUM:
- Single Out of Pocket Maximum - $7,000
- Family Out of Pocket Maximum - $14,000
MEMBER COPAYMENT(S):
- Preventative Exam - 0% no deductible
- Primary Care (PCP) - Office Visit - 0% after deductible
- Specialist - Office Visit - 0% after deductible
- Urgent Care Facility - 0% after deductible
- Emergency Room Visit - 0% after deductible
EMPLOYEE CONTRIBUTION - PER PAY (26 Pays):
- Employee - $76.38
- Employee+Spouse - $148.15
- Employee+Child(ren) - $144.55
- Family - $227.14
Dental - Guardian
You have the freedom to select the dentist of your choice; however, when you visit a participating PPO or Premier dentist, you will have lower out-of-pocket costs, no balance billing, and claims will be submitted by your dentist on your behalf. Out of network dentists may bill you for the difference between the contracted rate and the dentist’s fee. Reimbursement is based on the usual, reasonable & customary rate (UCR). In addition, insurance claim payments for out of network dentists are paid directly to the member and the member must pay the provider.
IN NETWORK:
NETWORK: DentalGuard Preferred
DEDUCTIBLE:
- Single Deductible - $50
- Family Deductible - $150
*Deductible applies when receiving Basic or Major services (Does not apply for Preventive & Ortho Services)
CLASS I: - Covered at 100% with no deductible
Diagnostic and Preventive Services - Exams, cleanings, fluoride, space maintainers, sealants, x-rays.
CLASS II: - Covered at 90% after deductible
Basic Services - Fillings, anesthesia, oral surgery, extractions
CLASS III: - Covered at 50% after deductible
Major Services - Fixed bridgework, dentures, crowns, implants, endodontics (not root canals), periodontal services (gums), Endodontics and Periodontics.
EMPLOYEE CONTRIBUTION - PER PAY (26 Pays):
- Employee - $3.15
- Employee+1 - $6.46
- Family - $11.91
Vision - VSP
IN NETWORK (VSP Choice Network):
Vision Exam - $10
COVERED SERVICES – LENSES / FRAMES
Single Lenses - $15
Bifocals - $15
Trifocals - $15
Frame Allowance
- $180 allowance for a wide selection of frames
- $200 allowance for featured frame brands
- 20% savings on the amount over your allowance
- $100 Walmart®/Costco® frame allowance
Contact Lens Allowance
- $150 allowance for contacts and contact lens exam (fitting and evaluation)
- 15% savings on a contact lens exam (fitting and evaluation)
Disability - Short Term / Long Term - MetLife
Everyday illnesses or injuries can interfere with your ability to work. Even a few weeks away from work can make it difficult to manage household costs. Short Term Disability coverage provides financial protection for you by paying a portion of your income, so you can focus on getting better and worry less about keeping up with your bills.
Serious illnesses or accidents can come out of nowhere. They can interrupt your life, and your ability to work for months – even years. Long Term Disability provides financial protection for you by paying a portion of your income, so you have financial support to manage your disability and your household.
Life Insurance - MetLife
Life insurance is an important part of your financial security. Life insurance helps protect your family from financial risk and sudden loss of income in the event of your death. AD&D insurance is equal to your Life benefit in the event of your death being a result of an accident and may also pay benefits for certain injuries sustained.
401(k)
Contact Us
Additional Contacts
Haley Lancaster
Human Resources Manager
HaleyL@thepdigroup.com
216-271-7344